The RACGP is releasing the consultation draft of the Guidelines for the management of hip and knee osteoarthritis (2nd edition). This guideline has been developed by a multidisciplinary expert working group and is based on the systematic identification and synthesis of best available scientific evidence.

The draft guidelines provides recommendations for general practitioners and other health professionals who treat osteoarthritis in an Australian healthcare setting. The RACGP is seeking your feedback on the guideline with recommendations in the following key clinical areas:

Non-pharmacological interventions for adults with symptomatic OA of the hip and/or knee

Pharmacological interventions for adults with symptomatic OA of the hip and/or knee

The Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce) will continue to consult with the general practice profession in 2017 regarding feedback on and changes to the MBS.

As part of this ongoing process, the RACGP welcomes any feedback you have about MBS items used in general practice (eg value, clinical necessity, appropriateness of services) and the work of the Taskforce. Your feedback will be collected and used to respond to the appropriate reports as needed, or otherwise communicated to the Taskforce. We welcome feedback on all general practice items – whether or not they have yet appeared in reports from the Taskforce.

Background

The Department of Health announced the formation of the Taskforce in April 2015, as part of the Government’s Healthier Medicare initiative. The 2017-18 Federal Budget allocated funding for the MBS Review Taskforce to continue for another three years until 2020.

The Taskforce aims to review all current MBS items and the services they describe. It has so far released various reports for consultation, which the RACGP has provided submissions to based on member feedback. The RACGP has responded to:

The Taskforce plans to release further reports for public consultation in 2017.

We will continue to provide details of the Taskforce’s reports as they are released, highlighting recommendations that affect general practice. Information about future reports and calls for specific consultations will be published in In Practice.

Engagement with Primary Health Networks

July 2015 saw the establishment of 31 Primary Health Networks (PHN), with the primary objectives of increasing the efficiency and effectiveness of medical services for patients and improving coordination of care. There are a variety of ways in which PHNs can engage with and provide support to general practices.

In a recent poll conducted by the RACGP regarding PHN engagement with GPs, almost half of respondents (47%) noted their PHN has little presence or involvement in their practice, while a further quarter of respondents (25%) noted no PHN presence or involvement in their practice. Only a small percentage of respondents (10%) noticed a significant presence or involvement from their PHN.

Having general practice representatives on PHN Clinical Councils should allow for effective representation of the profession. In such a role, GPs should be involved in informing the development of PHN strategy in their region.

The RACGP wants to continue its dialogue with GPs on PHN Clinical Councils about their engagement and experience as part of these networks, as well as other GPs’ experience with their PHN.

We welcome feedback on PHN engagement in your region, whether you hold a position on a Clinical Council or not. We would like to hear from you about:

the extent to which your PHN engages with you and/or your practice, and how meaningful and effective any engagement has been

if you are a representative on a Clinical Council:

how your Clinical Council is operating, including how you are currently engaged by your PHN

whether you are satisfied with the level of input your Clinical Council requires of you.

Feedback will inform the RACGP’s understanding of PHN and general practice interaction. We are happy to receive feedback anonymously; however, noting there will be wide variability across regions, can you please include your location. Your consent will be sought if any examples are considered for public use (if feedback is identifiable).

Proposed changes to the recommended use of human papillomavirus (HPV) vaccines

The Australian Technical Advisory Group on Immunisation (ATAGI) is consulting with stakeholders on proposed changes to the HPV vaccination recommendations for inclusion in the Australian Immunisation Handbook.

The Therapeutic Goods Administration registered Gardasil 9 as a 2-dose schedule in June 2017 and the Pharmaceutical Benefits Advisory Committee recommended in July that it be provided through the National Immunisation Program (NIP). The vaccine is expected to be available in Australia from 2018. These changes have prompted a review of the HPV recommendations in the Australian Immunisation Handbook, and the proposed changes reflect the current best clinical practice for prevention of HPV infection and associated disease.

RACGP Standards for after-hours services

The draft RACGP Standards for after-hours services (Standards for after-hours services) have been released for consultation. To ensure the Standards for after-hours services are meaningful to the profession and other stakeholders, we invite interested individuals and organisations to review the draft and provide feedback.

There will be further revisions to successive drafts of the Standards for after-hours services based on feedback received. To be accredited against the Standards for after-hours services, a service must first meet the RACGP’s definition of an after-hours service for the purposes of accreditation. Similar to the requirements for general practices, the after-hours services would then be required to meet the following modules:

Core

Quality Improvement

After-Hours Services.

Given that the Core and Quality Improvement modules apply to a variety of general practice settings (including after hours), they have been included for context. Questions have been included in the draft Standards for after-hours stakeholders to consider. The RACGP Patient Feedback Guide and the Resource Guide are also available for reference (see link below).

Please submit your feedback to standards@racgp.org.au by 29 September 2017. All stakeholder feedback will be published, unless you state otherwise.

The RACGP is proud to release the consultation draft of Putting prevention into practice: guidelines for the implementation of prevention in the general practice setting (the Green book).

The Green Book is a practical evidence-based implementation resource for GPs, practice staff and PHNs from the RACGP.

It brings together the evidence and lessons learned from the literature and real life general practice experiences to make implementation of preventive activities as straightforward, effective and successful as possible. Containing real-life case studies and ideas to reflect on, the Green book provides practical processes, strategies and tools for implementing and sustaining preventive activities in the practice setting.

The RACGP is seeking input from GPs, members of the practice team and groups working with general practices such as Primary Health Networks.

Your views and ideas will help inform the further refinement of the Green book. The consultation draft can be accessed here and feedback survey can be accessed here. Consultation on the 3rd edition Green book draft closes at 5.00pm on 15 September 2017.

23 October 2017

My Health Record secondary use of data consultation

Under the My Health Records Act 2012, health information in the My Health Record may be collected, used and disclosed “for any purpose” with the consent of the healthcare recipient. In addition, one of the functions of the System Operator (the Australian Digital Health Agency) is “to prepare and provide de-identified data for research and public health purposes.” Before these provisions of the Act will be implemented, a framework for secondary use of My Health Record system data must be established.

The Department of Health have launched a public consultation process to develop a framework and draft implementation plan for the secondary use of data in the My Health Record for research, policy, planning, system use, quality improvement, and evaluation activities. You can view the consultation paper here. [http://www.myhealthrecorddata.healthconsult.com.au/public-consultations/]

Your feedback is needed to ensure the RACGP submission appropriately reflects the views of general practice. You can view the consultations document and provide feedback here. All feedback must be received by the RACGP by COB Monday 23 October.

The Department of Health are also seeking views and ideas from the broader community such as patients, health care providers and those seeking access to My Health Record data for secondary purposes such as government, non-government, private organisations; universities and the research sector. To get involved visit the website. [http://www.myhealthrecorddata.healthconsult.com.au/]

11 September 2017

First Principles Review of the Indemnity Insurance Fund

The Department of Health is undertaking a First Principles Review of all of the Commonwealth funded schemes under the Indemnity Insurance Fund.

The RACGP is seeking your comments or feedback on the issues raised in this discussion paper, for the purpose of providing feedback to the Department of Health on the Review. Please submit your feedback to advocacy@racgp.org.au by Monday 11 September 2017.

There are a number of consultation questions provided throughout the discussion paper regarding each of the schemes, however you are welcome to provide general feedback that relates to concerns or issues with the Indemnity Insurance Fund or any of the specific elements. In the discussion paper, the Department of Health has identified some of the key issues regarding the operation each of the schemes, and poses questions about whether they remain fit for purpose and how they can be improved.

Background

The Indemnity Insurance Fund comprises seven Commonwealth government assistance schemes. The four schemes that directly concern general practice, as well as the issues associated with them, have been outlined in brief below.

1. Premium Support Scheme (PSS)

Medical practitioners qualify for a premium subsidy under the PSS if they meet one of two criteria:

they are a procedural general practitioner (GP) practising in a rural or remote area.

DoH have identified the following challenges or issues with the PSS in the discussion paper:

decreasing demand

access to subsidy

eligibility for subsidy and level of subsidy

advance payments

universal cover arrangements

2. High Cost Claims Scheme (HCCS)

The HCCS pays 50% of the cost of eligible claims over the threshold of $300,000. Claims are reimbursed by the Commonwealth to the medical indemnity insurer. The threshold increases from $300,000 to $500,000 for claims notified from 1 July 2018.

DoH have identified the following challenges or issues with the HCCS in the discussion paper:

the scope of the scheme (i.e. who it applies to)

the threshold above which the Commonwealth contributes

the level of the Commonwealth’s contribution

the costs that should be paid by the Commonwealth (as part of its contribution)

3. Exceptional Claims Scheme (ECS)

The ECS reimburses medical indemnity insurers for 100% of the cost of private practice claims that are above the limit of their medical indemnity insurance contract limit, typically $20 million.

DoH have identified the following challenges or issues with the ECS:

whether or not it is required given that absence of claims made under the scheme.

4.Run-Off Cover Scheme (ROCS)

The ROCs reimburses medical indemnity insurers for 100% of the cost of claims for doctors who have ceased private practice because of retirement, disability, maternity leave, death, or if they stop working as a doctor in Australia. The ongoing costs of the scheme are met by the ROCS Support Payment, a levy on the premium income of medical indemnity insurers.

DoH have identified the following challenges or issues with the ROCS:

the scheme is complex legislatively

the scheme may be better managed by insurers rather than by Government

as the scheme funds 100% of the costs of a claim, there are incentives for medical practitioners and insurers to submit a claim via ROCS when there is uncertainty about whether a person has ceased practice

Report from the Intensive Care and Emergency Medicine Clinical Committee

Report from the Cardiac Services Clinical Committee

Report from the Endocrinology Clinical Committee

First report from the Pathology Clinical Committee on endocrine tests

There are a number of recommendations within these reports that may affect general practice services. A summary of these recommendations, along with accompanying notes from each report’s rationale, are provided below.

We welcome member feedback in relation to these recommendations, to help inform the RACGP’s response to the Taskforce.

Please note there are extensive recommendations made under the Cardiac Services report, which are summarised below.

Intensive care and emergency medicine

Recommendation 2 suggests the use of a consistent item framework for all emergency attendances, regardless of what type of medical provider attends to the patient. This recommendation focuses on improving billing transparency for patients and providers, by ensuring the item billed reflects the nature of the service provided.

The Taskforce have suggested that:

the gold standard for emergency care is vocational recognition as an Emergency Medicine Specialist by the Australasian College of Emergency Medicine – therefore, higher emergency medicine rebates should be retained for those with this recognition.

other providers (such as GPs) should be encouraged to gain emergency attendance experience, but because they provide a substantively different skillset, with substantively different level of ED attendance service, they should not attract higher rebates.

there are no substantive differences between emergency medicine services provided by VRGPs and non‐ VRGPs. Many non‐VRGPs have substantial experience in providing services in the ED context.

Pathology – Endocrine tests

Recommendation 1 seeks clearer guidance on when the TSH (thyroid-stimulating hormone) test for item 66716 is appropriate for doctors to request.

The Pathology Clinical Committee agrees that TSH should not be used as a screening test in asymptomatic patients, as recommended by the RACGP Choosing Wisely guidelines and international guidelines.

Recommendation 4 seeks the removal of item 66545 (Oral glucose challenge test) from the MBS and the consolidation of items 66542 under 66548 and include use in pregnant women and certain specific patient groups. In support of this recommendation, the Committee has said:

In pregnancy the glucose challenge test has been superseded by the full glucose tolerance test. This has been recommended by the Australian Diabetes in Pregnancy Society.

While there are still recommendations by the RACGP that women with a history of gestational diabetes have an OGTT 6–12 weeks postpartum, there is a recognition that a shift to HbA1c might improve adherence with testing.

The Endocrinology Clinical Committee advised:

Changing the item descriptors to explicitly include the maximum number of tests permitted under rule 25, which is four tests in a 12-month period for item 66551 and six tests for pregnant patients under item 66554. For example, the proposed item descriptor for item 66551 is as follows: ‘Quantitation of glycated haemoglobin performed in the management of pre-existing diabetes; maximum four tests in a 12-month period (Item is subject to rule 25).’

Cardiac services

The Cardiac Services Clinical Committee’s (the Committee) report provides recommendations on the following areas:

Cardiac imaging

General

CAD-related

Electrocardiography (ECG)

AECG and electrophysiology

Cardiac surgery

The majority of the Committee’s report focuses on Cardiac surgery, for which there are no recommendations identified as affecting general practice.

Throughout the other areas, there are a number of matters for review as outlined below.

Cardiac imaging recommendations

Recommendation 3 relates to the gatekeeper for cardiac imaging, recommending EST as an appropriate first line investigation in low risk patients.

For GPs, Consultant Physicians and Cardiologists, standard EST (rather than stress echo or MPS) should be the first-line investigation for symptomatic adult patients with suspected CAD and an Australian Absolute risk score for cardiovascular event of less than 10 per cent over 5 years, and who have an interpretable ECG and are able to exercise. This should be reflected in the revised MBS descriptors.

The Committee recommended that a GP education campaign be undertaken regarding the appropriate use of cardiac imaging modalities and other cardiac investigations.

Recommendation 5 relates to myocardial perfusion scans, recommending the schedule fee for the single rest items should be revised such that the combined fee for the separate rest and stress items is equal to the fee for the combined item.

Conduct a GP education campaign focused on the appropriate use of cardiac imaging modalities and investigations, including EST, stress echo, MPS, ICA and CTCA.

The Committee recommended that a GP education campaign be undertaken regarding the appropriate use of cardiac imaging modalities and other cardiac investigations.

General recommendations

Recommendation 10 relates to Heart Teams, recommending that two new services should be added to the MBS for Heart Team case conferences. The Committee:

recommended creating two new items for Heart Team consultations in order to increase the likelihood that patients receive the most appropriate treatment for their condition.

recommended that a Heart Team should include a minimum of three providers, and that the items should be claimable by a maximum of six providers including the convenor. The conference should include a GP or non-interventional specialist and, where a decision on revascularisation is required, a cardiac surgeon and interventional cardiologist.

recommended Heart Team case conferences require a letter or copy of the recommendation to be provided to the patient’s GP if they are not present for the conference.

agreed that face-to-face attendance is desirable. However, telemedicine is important for rural and remote access, and the Committee therefore recommended permitting telemedicine attendance by GPs or offsite providers who bring specific expertise to the conference.

CAD-related recommendations

Recommendation 14 relates to CT coronary angiography (CTCA), recommending the proposed structure of the CTCA item into the 3 items, including an item for GP access to CTCA.

The Committee agreed that CTCA is a robust test with a very strong negative predictive value in terms of outcomes. However, the CTCA item with limited GP access carries the risk of considerable uptake (as the Department noted had occurred with GP access to knee MRI). This risk is expected to be mitigated (to some extent) for the following reasons:

many CTCAs ordered by a GP would otherwise have been ordered by a cardiologist;

the test can only be ordered following Absolute risk assessment; and

the test cannot be repeated in patients in whom the result is positive, or within five years of a negative result. Nonetheless, the Committee acknowledged this risk and recommended that the MSAC reviews these changes prior to implementation.

If the item is not well defined, there is a risk that poorly informed providers will use the test for screening, or for other low-value indications due to pressure from patients.

A concern was raised about the potential risk of GP overuse of this item leading to significant volume increases, similar to past experiences noted by the Department with GP access to services such as knee MRI. Ensuring GPs and providers strictly comply with the indications for the test is intended to avoid over-usage of the test.

The Committee agreed that a targeted GP education program should be implemented. Education for GPs, whether provided by professional bodies or the Department, may improve the effectiveness of GPs as gatekeepers and custodians of health system resources.

It was also suggested that the ability to refer for the new GP-access CTCA item could be made dependent on the completion of an education module.

Non-invasive CAD investigations

Respondents are asked whether they agree with the diagram relating to non-invasive CAD investigations which may be requested by a GP or other provider.

New explanatory notes to include: “A GP referral to a cardiologist or consultant physician for a standard consultation should not be regarded as a referral for an ECG.”

The Committee determined that item 11700 should remain on the MBS in recognition of the access it gives GPs—particularly rural GPs—to specialist review of a trace. Although all doctors should be capable of interpreting ECGs, the Committee acknowledged that GPs (and other clinicians) who are concerned about a trace, or are unable to obtain an adequate trace, should be able to seek additional support.

The Committee agreed that it is important to continue remunerating GPs for this service.

Background In April 2015, the Department of Health announced the formation of the Medicare Benefits Schedule (MBS) Review Taskforce as part of the Government’s Healthier Medicare initiative. The 2017-18 Federal Budget allocated funding for the MBS Review Taskforce to continue for another three years until 2020.

Australian General Practice Training Program (AGPT) 2016 Salary support Program Review

The program which was implemented in 2010, was originally intended to provide GP registrars with a 12-month period of exposure in an Aboriginal and Torres Strait Islander health setting during their core vocational training.

RACGP Aboriginal and Torres Strait Islander Health identified that the quality of training in Aboriginal and Torres Strait Islander health training posts must be the key priority of the program. The faculty consulted widely and prepared its response based on the feedback received. To view the RACGP’s submission, please visit https://www.racgp.org.au/yourracgp/news/reports/

The MBS Review Taskforce released six reports for public consultation – recommendations in the reports may affect you, your practice and your patients. The reports released for public consultation included:

To inform the RACGP’s Submission to the MBS Review Taskforce on each of these reports, we called for member feedback on the recommendations, focussing on:

Diagnostic Imaging – knee imaging

Recommendations 2

Urgent after-hours primary care services funded by the MBS

Recommendations 2

Recommendations 2

Dermatology, Allergy and Immunology

Recommendations 5.2, 5.3, 5.4, 5.5, 5.8, 5.10

Background

In April 2015, the Department of Health announced the formation of the Medicare Benefits Schedule (MBS) Review Taskforce as part of the Government’s Healthier Medicare initiative. The 2017-18 Federal Budget allocated funding for the MBS Review Taskforce to continue for another three years until 2020.

27 April 2017

2017 update of the RACGP’s MBS fee summary

The Medicare Benefits Schedule (MBS) currently contains more than 5700 items, is 903 pages long and outlines all Medicare item numbers for GPs, other medical specialists and other health practitioners.

Our MBS fee summary provides members with a quick and easy guide to the item numbers relevant to general practice. We update this widely used resource annually to reflect changes to the MBS.

To produce an updated MBS fee summary that meets your needs, we are calling for feedback and suggestions for the 2017 edition. We invite you to comment on the following areas:

additions, removals or amendments to the items listed in the 2016 MBS fee summary

additional content not previously included in the MBS fee summary (eg DVA rebates)

Changes made to the MBS since the release of the 2016 version will be incorporated into this update, including updates to skin service and wrist and finger fracture items. Medicare’s 1 May 2017 updates will also be incorporated into this version before it is finalised if relevant to general practice.

8 February 2017

In 2016, a Senate inquiry was conducted into the medical complaints process in Australia, focused on the prevalence, reporting and processing of bullying and harassment complaints in the medical profession. During the consultation a number of concerns were raised regarding administration and implementation of the complaints process. The Senate Committee recommended that a new inquiry be established to focus on the process itself, rather than the ways in which the process can be used and misused.

The focus of the current inquiry:

The Senate Community Affairs References Committee (the Committee) have announced a new inquiry looking into the complaints mechanism administered under the Health Practitioner Regulation National Law. The inquiry will address the following matters:

the implementation of the current complaints system under the National Law, including the role of the Australian Health Practitioner Regulation Authority (AHPRA) and the National Boards; whether the existing regulatory framework, established by the National Law, contains adequate provision for addressing medical complaints; the roles of AHPRA, the National Boards and professional organisations, such as the various Colleges, in addressing concerns within the medical profession with the complaints process; the adequacy of the relationships between those bodies responsible for handling complaints; whether amendments to the National Law, in relation to the complaints handling process, are required; and other improvements that could assist in a fairer, quicker and more effective medical complaints process. The new inquiry focusses on the complaints mechanism more broadly - including how patient complaints are managed.

The RACGP sought feedback from members with experience surrounding the complaints mechanism and processes, particularly regarding the matters identified by the Committee above. The feedback and suggestions will help to inform the RACGP submission to the Committee’s inquiry.

The Australian Digital Health Agency (the Agency) has recently released the National Digital Health Strategy Consultation. The findings from this consultation will be used by the Agency to identify new ways to deliver more effective and efficient health and care, and guide the development of a national digital health strategy for delivery to Government in 2017.

Use of secure electronic communications

Patients are required to interact with multiple healthcare professionals or organisations in different physical locations. In order to provide high quality, effective and safe healthcare, there has to be efficient communication between general practitioners and other healthcare providers involved in a patient’s care. Secure electronic communication is currently one of the most efficient methods of communication. The RACGP would like to see the elimination of paper forms in general practice within three years. There are however a range of concerns that members may have with the increased use of electronic forms. In September 2016, the RACGP released a position statement: The use of secure electronic communication within the health care system. This outlines support for the following principles for electronic communication between general practice and other healthcare agencies:

all electronic communications templates and systems should use existing data and information from general practice clinical information systems to pre-populate documents and forms

all communications should be

created and sent from within the general practice’s electronic clinical software system and

automatically received into the local patient electronic health record via the clinical software system inbox

all electronic communications to external healthcare providers and agencies should be sent securely using secure messaging to align with best practice data privacy handling principles to protect patient privacy and confidentiality.

The RACGP sought feedback on what challenges you face in increased use of two-way secure electronic communication; completing forms for corporate and government agencies, as well as your reasons for using electronic forms.

Results from this consultation were published in In Practice on 16 December 2016.

9 November 2016

Redesigning the Practice Incentives Program

In the 2016-17 Federal Budget, the Australian Government announced a review of the Practice Incentives Program (PIP). The Department of Health has released a consultation paper on Redesigning the Practice Incentives Program and is seeking stakeholder feedback on the redesign.

The stated intention of the redesign is to reduce the administrative burden associated with multiple PIP payments and move towards a streamlined and simplified system. The redesign will introduce a Quality Improvement Incentive to replace 7 of the 11 incentives in the current PIP. It is anticipated that funds available through the redesigned PIP will remain unchanged from current levels. The After-hours, eHealth, Rural Loading and Teaching incentives will not be affected by the PIP redesign.

The RACGP is seeking your feedback on a number of key questions raised in the consultation paper. In addition to the questions raised in the paper, the RACGP is also seeking your feedback on the two preliminary redesign options outlined on page 15 – 16 of the consultation paper.

The RACGP consultation period closes on Wednesday 9 November 2016.

The Consultation paper raises the following key questions:

What are the strengths of the current PIP? How has the PIP influenced your quality improvement work to date? What elements of the current PIP should be kept and which should change? What aspects of the current PIP can be improved through better use of technology? What is the best way to ensure the PIP funds meet the principle for efficient, effective and economical and ethical use of public money? How would we ensure that the needs of Aboriginal and Torres Strait Islander people are considered and continue to be met under a redesigned PIP? Would you participate in a patient focussed quality improvement PIP incentive? What are the key aspects of quality improvement that should be captured in a redesign of the PIP? Would you like to provide an example of a quality Practice improvement incentive payment as outlined? Do you support the use of collated regional data for population health and planning purposes? Do you have any suggestions to improve the proposed Quality Improvement Incentive payment?

30 October 2016

5th edition Standards: Patient Feedback Guide

The RACGP is currently developing the 5th edition of the Standards for general practices (the Standards), to be released in October 2017.

Feedback from stakeholders and practices on patient feedback in 4th edition Standards indicates that the requirements are too prescriptive and focus on the process for collecting the feedback rather than the outcome.

As a result of the feedback received and the move to more outcomes focused Indicators in the 5th edition Standards, the requirements relating to patient feedback have been modified to provide increased flexibility for practices in how they undertake patient feedback.

► A. Our practice seeks feedback from patients, carers and other relevant parties in accordance with the RACGP Patient Feedback Guide: learning from our patients (the Patient Feedback Guide). ► B. Our practice can demonstrate how we have analysed and responded to feedback and considered feedback for quality improvement ► C. Our practice promotes how we have responded to feedback and used feedback for quality improvements.

The above Indicators focus on the importance of:

collecting the feedback

analysing the feedback

using the feedback for quality improvement purposes.

In order to reflect the requirements of the Indicators in the 5th edition Standards, the Patient Feedback Guide has been revised and updated.

The RACGP will consider all feedback received to inform the next draft of the Patient Feedback Guide. The Patient Feedback Guide will be released with the 5th edition Standards in October 2017. For more information on the development of the 5th edition Standards visit the Standards development page.

31 October 2016

Responding to financial pressures with newbusiness models and billing practices

As highlighted in September’s Good Practice, GPs and their practices are looking at their financial bottom line to determine how they can remain viable in response to the Medicare freeze. Many practices are adapting to the landscape by shifting billing models, and introducing copayments and other fees so that they can combat financial pressures and continue to provide quality general practice services to their patients.

The RACGP is looking to prepare case studies of GPs and practices adapting to inform members of what their peers are doing. We invited members to answer our poll below and provide information regarding any models or approaches their practice has implemented (successful or otherwise).

Respondents were asked to comment on:

the triggers that made you contemplate change

the obstacles you faced, and whether/how these were overcome

patient reactions to change

how you assessed success

what made your plan effective, or otherwise.

7 October 2016

Putting prevention into practice: guidelines for the implementation of prevention in the general practice setting (the Green book).

The RACGP is developing a new edition of the Green book. The Green book is the companion to the RACGP Guidelines for preventive activities in general practice (the Red book), and is designed to be a practice resource to strengthen prevention activities in general practice.

The guide is intended to improve professional relationships between GPs and other medical specialists. While it provides advice on referrals by GPs to specialists, it does not address how other medical specialists manage GP referrals.

Some of the issues currently being considered by the RACGP and identified in recent commentary include other medical specialists:

asking for a new referral for a patient with the same ongoing problem every 12 months

at times not acknowledging or responding to referrals from GPs

at times not accepting indefinite or timed referrals from GPs other than 12 months

inconsistently communicating with the referring GP about any referrals to other specialists.

In this consultation, the RACGP sought member feedback on these issues and any additional experiences relating to how other medical specialists’ have handled your referrals. Feedback will inform our advocacy on behalf of GPs on these issues.

In April 2015, the Department of Health announced the formation of the Medicare Benefits Schedule (MBS) Review Taskforce as part of the Government’s Healthier Medicare initiative. The Taskforce is reviewing the MBS in its entirety, considering individual items as well as the rules and legislation governing their application. The first review from the MBS Review Taskforce was released at the end of 2015, with 23 items removed from the MBS. An Interim Report to the Minister for Health was released on 6 September 2016. The MBS Review Taskforce’s Clinical Committees released six Clinical Committee reports and the First Report of the MBS Principles and Rules Committee for public consultation. The reports released for public consultation include:

First report of the MBS Principles and Rules Committee

Report from the Gastroenterology Clinical Committee

Report from the Obstetrics Clinical Committee

First report from the Diagnostic Imaging Clinical Committee – Low Back Pain

First report of the Ear, Nose and Throat Surgery Clinical Committee on Tonsillectomy, Adenoidectomy & Insertion of Grommets

The MBS Review Taskforce called on health professionals to have their say about the recommendations proposed by the Clinical Committees, prior to consideration by the MBS Taskforce and subsequent recommendations being made to Government.

In order to inform the RACGP’s Submission to the MBS Review Taskforce on each of these reports, we called on member feedback on the recommendations made within each.

27 May 2016

Extension of freeze on MBS patient rebates - tell us how it will affect you and your practice

On 3 May 2016, as part of its 2016–17 Federal Budget, the federal government announced an extension of the freeze on the Medicare Benefits Schedule (MBS) for a further two years until 30 June 2020.

The extension of the MBS freeze will have significant implications on the affordability of vital health services and the overall sustainability of general practice. There is now an even greater likelihood of reduced access for patients and higher out of pocket costs, as GPs strive to maintain viable practices.

In 2015, the RACGP surveyed members on how the freeze was affecting patient services, with the majority of respondents saying they would be forced to pass increased out-of-pocket expenses onto patients.

The continued freeze and its extension until 2020 demonstrates the federal government’s sustained efforts to ignore and devalue GPs and the crucial services provided by general practices.

The RACGP will increase advocacy efforts to have the indexation freeze lifted. To assist us with our efforts, we asked to hear your stories and examples of how the freeze is impacting you, your patients and your community and how you and your practice will adapt.

The RACGP thanks all respondents for their feedback. We will use this information in continued advocacy efforts for appropriate indexation of Medicare rebates.

The RACGP’s You’ve been targeted campaign includes further information for both GPs and patients on how the freeze will affect them, including fact sheets, posters and letters to send to local candidates.

the prevalence of bullying and harassment in Australia’s medical profession;

any barriers, whether real or perceived, to medical practitioners reporting bullying and harassment;

the roles of the Medical Board of Australia, the Australian Health Practitioners Regulation Agency and other relevant organisations in managing investigations into the professional conduct (including allegations of bullying and harassment), performance or health of a registered medical practitioner or student;

the operation of the Health Practitioners Regulation National Law Act 2009 (the National Law), particularly as it relates to the complaints handling process;

whether the National Registration and Accreditation Scheme, established under the National Law, results in better health outcomes for patients, and supports a world-class standard of medical care in Australia;

the benefits of ‘benchmarking’ complaints about complication rates of particular medical practitioners against complication rates for the same procedure against other similarly qualified and experienced medical practitioners when assessing complaints;

the desirability of requiring complainants to sign a declaration that their complaint is being made in good faith; and

any related matters.

The RACGP is seeking your feedback regarding the medical complaints handling process in Australia, including any further information you feel is relevant to this inquiry.

New MBS Proposal – Fibroscan for the diagnosis of liver fibrosis in patients with hepatitis B or C

The Medical Services Advisory Committee (MSAC) are considering an application for a new MBS item using Transient Elastography (TE, known by its trade name, Fibroscan) for the diagnosis of liver fibrosis in patients with chronic hepatitis B or hepatitis C.

The RACGP are seeking member views and feedback to assist us in developing a response. Specifically, MSAC are seeking feedback on:

The clinical utility of Fibroscan for patients with hepatitis C or hepatitis B

The diagnostic information offered by Fibroscan compared to the information provided through other currently available tests. For example, what benefits does Fibroscan offer over other existing diagnostic services? Does the use of Fibroscan change treatment options/regimes for patients?

Dissemination of the service into gastroenterology and GP practices. Is this service currently offered? And if so, in what type of practices? Would an MBS rebate affect uptake for this service?

Development of the 5th edition Standards for general practices

The Royal Australian College of General Practitioners (RACGP) develops the RACGP Standards for general practices (the Standards). The Standards are designed as a template for quality care and risk management in Australian general practice as well as a framework for good practice in the ongoing operation of a general practice.

The RACGP has now concluded its Second Consultation Phase for the 5th edition Standards for general practices . In this Phase, the RACGP sought the views of stakeholders regarding the first draft of the Standards.

It is important to note that this first draft of the 5th edition Standards is a working draft. There will be further revisions to successive drafts of the Standards based on feedback received which will be released for stakeholder feedback prior to the release of the 5th edition Standards in October 2017.

Emerging after-hours services in Australia

The number of Medical Deputising Services (MDS) and dedicated after-hours services operating across Australia have increased significantly in recent years. It appears that the increase in the number of MDS and after-hours services has been driven by a number of factors:

difficulties in attracting GPs to work unsociable hours and difficulties in securing appropriate support and financial incentives

other factors impacting the sustainability and viability of general practice (rebate freeze, inadequate support).

General practice has a long history of working with after-hours services. However, there have recently been concerns raised by RACGP Members regarding some after-hours services currently operating across Australia.

To date, particular concerns raised by RACGP Members include:

fragmentation of care when there is no link to an established GP or practice

the lack of infrastructure within some of these services which does not support the provision of quality care

the aggressive approach to advertising that some services undertake, highlighting an entrepreneurial type of business model (making these services more appealing to patients)

the increase in the use of after-hours patient rebates, and urgent after-hours items.

The RACGP Expert Committee – General Practice Advocacy and Funding (REC-GPAF) is currently considering the impacts of after-hours services on the provision of quality primary healthcare after-hours services in Australia.

To progress this work the REC-GPAF is seeking feedback regarding these types of services from the broader RACGP Membership.

All comments and feedback received will be used to ensure the RACGP is best placed to represent the views of the profession in its future advocacy work.

The RACGP is seeking feedback on Cancer Council Australia’s Draft clinical management guidelines for the prevention of cervical cancer . These guidelines will supersede the NHMRC approved 2005 Guidelines Screening to prevent cervical cancer: guidelines for the management of asymptomatic women with screen-detected abnormalities .

With the change to primary HPV testing it was necessary and timely to review the 2005 Guidelines and to consider recent evidence to formulate guidelines that are relevant to primary HPV testing and triage using liquid-based cytology. The guidelines aim to assist women and health professionals to achieve best outcomes in clinical management of women with screen-detected cervical abnormalities.

The Guidelines were commissioned by the Department of Health to support the renewed National Cervical Screening Program coming into effect on 1 May 2017. Larissa Roeske is on the Guidelines committee and Amanda McBride is the RACGP Rep on the steering committee for the National Cervical Screening Program.

The RACGP has sought feedback on the Committee’s terms of reference (below) and the challenges for GPs of working in residential aged care facilities or in aged care more generally.

Inquiry into the future of Australia’s aged care sector workforce

Terms of reference:

the current composition of the aged care workforce;

future aged care workforce requirements, including the impacts of sector growth, changes in how care is delivered, and increasing competition for workers;

the interaction of aged care workforce needs with employment by the broader community services sector, including workforce needs in disability, health and other areas, and increased employment as the National Disability Insurance Scheme rolls out;

challenges in attracting and retaining aged care workers;

factors impacting aged care workers, including remuneration, working environment, staffing ratios, education and training, skills development and career paths;

the role and regulation of registered training organisations, including work placements, and the quality and consistency of qualifications awarded;

government policies at the state, territory and Commonwealth level which have a significant impact on the aged care workforce;

relevant parallels or strategies in an international context;

the role of government in providing a coordinated strategic approach for the sector;

challenges of creating a culturally competent and inclusive aged care workforce to cater for the different care needs of Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse groups and lesbian, gay, bisexual, transgender and intersex people;

The RACGP provided comment on the first round of recommendations from MBS Review Taskforce Clinical Committees on items that they considered obsolete and should be removed from the MBS. The RACGP broadly supported the Clinical Committee recommendations and welcomed the inclusion of GPs on the committees. However, the RACGP is concerned that savings found from removing items from the MBS will not be reinvested into healthcare.